Updates to Colorectal Cancer Screening Coding

CMS’ first quarter update to HCPCS Level II codes included deletion of three codes to report colorectal cancer screening with barium enema. Coverage for these codes was halted and other coverage expanded as of Jan. 1, 2025.

Where can I find the updates?

All quarterly updates to HCPCS Level II codes and modifiers can be found at this link to the CMS website: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update.

Deletion of HCPCS Level II Codes

Medicare has decided to remove coverage for barium enema as a method of screening for colorectal cancer, and delete the corresponding HCPCS Level II codes, due to rare use among Medicare beneficiaries. Additionally, this exam is no longer being recommended as an evidence-based method of screening given the advancement of alternatives such as stool-based tests, colonoscopies, and CT colonography. The codes that have been deleted include the following:

• G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
• G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema
• G0122 Colorectal cancer screening; barium enema

Coverage Expansion

In response to updating coverage policies to better reflect current medical practice Medicare is expanding coverage to include other methods of screening for colorectal cancer.

For example, CMS is following the recommendation of The U.S. Multi-Society Task Force of Colorectal Cancer (MSTF) which states, “ …CT colonography has replaced double-contrast barium enema as the test of choice for colorectal imaging for nearly all indications. CT colonography is more effective than barium enema and better tolerated.”

Coverage updates include adding CT colonography as a covered service and making follow-on screening colonoscopy after a positive blood-based biomarker test part of the continuum of screening.

• 74263 Computed Tomographic (CT) Colonography, Screening, After Image Post-Processing – CMS is Adding coverage for performance of computed tomography colonography (CTC) for screening.
• G0327 (Colorectal cancer screening; blood-based biomarker) – CMS is expanding the concept of a “complete colorectal cancer screening” to include a follow-on screening colonoscopy after a Medicare covered blood-based biomarker CRC screening, as part of the continuum of screening.
• A blood-based biomarker test with a positive result will lead to a follow-on screening colonoscopy (with no beneficiary cost-sharing).
• CRC screening frequency limitations do apply to the follow-on screening colonoscopy in the context of “complete CRC screening. 

Note that CMS did not add coverage for the multi-target mRNA stool test called Colosense.

Organizations will want to ensure any relevant hard coding processes and/or EHR features reflect the deletion of these codes.

Key Takeaways

• Barium enema is no longer recommended as an evidenced-based method of screening for colorectal cancer
• Medicare has halted use of codes G0106, G0120 and G0122
• CMS is revising coverage policies to align with current screening recommendations from The U.S. Multi-Society Task Force of Colorectal Cancer (MSTF)
• CT colonography is being added as a covered service for Medicare beneficiaries
• Follow-on colonoscopy after positive blood-based biomarker test is being added to the continuum of screening.

Please visit the following HIA resources for additional instruction in outpatient coding for colonoscopy procedures:

• Blog Post: CPT Coding Guidelines Review: Colonoscopy
• Course: Colonoscopy Coding for Outpatients

References

• https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule
• https://www.federalregister.gov/documents/2024/12/09/2024-25382/medicare-and-medicaid-programs-cy-2025-payment-policies-under-the-physician-fee-schedule-and-other
  
  

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.